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HelpTest Code DRVI1 Dilute Russell's Viper Venom Time (DRVVT), with Reflex, Plasma
Ordering Guidance
Because no single coagulation test can identify or exclude all lupus anticoagulants (LA), and because of the complexity of testing LA, one of the following Coagulation Consultation reflexive panel procedures are recommended if clinically indicated:
ALUPP / Lupus Anticoagulant Profile, Plasma
AATHR / Thrombophilia Profile, Plasma and Whole Blood
APROL / Prolonged Clot Time Profile, Plasma
Additional Testing Requirements
Serum anticardiolipin antibody testing (CLPMG / Phospholipid [Cardiolipin] Antibodies, IgG and IgM, Serum) and anti-beta-2 glycoprotein I (B2GMG / Beta-2 Glycoprotein 1 Antibodies, IgG and IgM, Serum) antibody testing should also be performed in conjunction with coagulation-based testing for lupus anticoagulants to enhance detection of different types of antiphospholipid antibodies.
Shipping Instructions
Send specimens in the same shipping container.
Specimen Required
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.
2. Centrifuge, remove plasma, and centrifuge plasma again.
3. Aliquot into a separate plastic vial, leaving 0.25 mL in the bottom of the centrifuged vial.
4. Freeze plasma immediately (no longer than 4 hours after collection) at -20° C or, ideally, -40° C or below.
Additional Information:
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
Useful For
Detecting and confirming or helping to exclude the presence of lupus anticoagulants (LA)
Identifying LA that do not prolong the activated partial thromboplastin time (APTT)
Evaluating unexplained prolongation of the APTT or prothrombin time clotting tests
Distinguishing LA from a specific coagulation factor inhibitor or coagulation factor deficiencies
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| DRVI4 | DRVVT Interpretation | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| DRVI2 | DRVVT Mix Ratio | No | No |
| DRVI3 | DRVVT Confirmation Ratio | No | No |
Testing Algorithm
If dilute Russell's viper venom time (DRVVT) ratio is 1.20 or above, then DRVVT mix and DRVVT confirmation will be performed at an additional charge.
If DRVVT ratio is less than 1.20, the DRVVT mix and DRVVT confirmation will not be performed.
A DRVVT interpretation will always be performed.
Special Instructions
Method Name
Optical Clot-Based
Reporting Name
DRVVT Screen Ratio, w/Reflex, PSpecimen Type
Plasma Na CitSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma Na Cit | Frozen | 14 days |
Reference Values
Dilute Russell's viper venom time screen ratio: <1.20
Normal ranges for children: Not clearly established, but similar to normal ranges for adults, except for newborn infants whose results may not reach adult values until 3 to 6 months of age.
Interpretation
Dilute Russell's viper venom time screen ratio (<1.20):
A normal dilute Russell's viper venom time (DRVVT) screen ratio (<1.20) indicates that lupus anticoagulants (LA) is not present, or not detectable, by this method (but might be detected with other methods).
Abnormal DRVVT screen ratio (DRVVT screen ratio ≥1.20) may suggest the presence of LA; however, other possibilities include:
-Deficiencies or dysfunction of factors I (fibrinogen), II, V, or X, congenital or acquired.
-Inhibitors of factor V, or occasionally by inhibitors of factor VIII, or other specific or nonspecific inhibitors
-Anticoagulation therapy effects (see Cautions)
Further evaluation consists of performing mixing studies with an equal volume of normal pooled plasma (DRVVT 1:1 mix) to investigate the possibility of coagulation factor deficiency (suggested by DRVVT mix ratio <1.20) and to evaluate inhibition (suggested by DRVVT mix ratio ≥1.20) and mixing patient plasma with DRVVT reagent enriched in phospholipid (DRVVT confirmatory reagent) (DRVVT mix and DRVVT confirm ratios).
Possible combinations of results include the following:
-DRVVT screen ratio ≥1.20, DRVVT mix ratio <1.20, and DRVVT confirm ratio <1.20:
No evidence of LA. This data may reflect anticoagulation therapy effects or other (congenital or acquired) coagulopathy.
-DRVVT screen ratio ≥1.20, DRVVT mix ratio ≥1.20, and DRVVT confirm ratio <1.20:
The prolonged and inhibited DRVVT (DRVVT screen and mix ratios) may reflect presence of a specific factor inhibitor (eg, factor V inhibitor), anticoagulation therapy effects, or other nonspecific inhibitors as can be seen with monoclonal protein disorders, lymphoproliferative disease, etc. Although LA cannot be conclusively excluded, the DRVVT confirm ratio of ≤1.20 makes this less likely.
-DRVVT screen ratio ≥1.20, DRVVT mix ratio <1.20, and DRVVT confirm ratio ≥1.20:
Although mixing study of the prolonged DRVVT screen and mix ratios provides no evidence of inhibition, additional phospholipid shortens the clotting time (DRVVT confirm ratio), suggesting presence of LA.
-DRVVT screen ratio ≥1.20, DRVVT mix ratio ≥1.20, and DRVVT confirm ratio ≥1.20:
The data are consistent with presence of LA, provided anticoagulant effect can be excluded (see Cautions).
DRVVT assays ordered as a single, stand-alone test should be interpreted within patient clinical context and close attention to medication use by patient (see Cautions).
Clinical Reference
1. Proven A, Bartlett RP, Moder KG, et al. Clinical importance of positive test results for lupus anticoagulant and anticardiolipin antibodies. Mayo Clin Proc. 2004;79(4):467-475
2. Gastineau DA, Kazmier FJ, Nichols WL, Bowie EJ. Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Hematol. 1985;19(3):265-275
3. Brandt JT, Triplett DA, Alving B, Sharrer I. Criteria for the diagnosis of lupus anticoagulant: an update. On behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb Haemost. 1995;74(4);1185-1190
4. Arnout J, Vermylen J. Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease. J Thromb Haemost. 2003;1(5):931-942
5. Pengo V, Tripodi A, Reber G, Rand JH, et al. Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2009;7:1737-1740. doi:10.1111/j.1538-7836.2009.03555.x
6. Clinical and Laboratory Standards Institute (CLSI). Laboratory Testing for Lupus Anticoagulant; Approved Guideline. CLSI document H60-A. CLSI; 2014
Day(s) Performed
Monday through Friday
Report Available
1 to 4 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
85613
85613 (if appropriate)
85613 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| DRVI1 | DRVVT Screen Ratio, w/Reflex, P | 15359-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| RVRI1 | DRVVT Screen Ratio | 15359-3 |
Forms
If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.